Wounds are typically washed with normal saline. A bactericidal treatment may be applied and the wound is then covered with a dressing, typically cotton gauze. This may be suitable for many wounds, but not all. Some wounds bleed proficiently, so a hemostatic agent may be applied to control the bleeding. Other wounds, such as large surface area wounds as may be seen in a motorcycle accident where extensive road abrasion to the skin has occurred, may exhibit significant blood loss merely because of the large surface wound involved, even though the wound itself may be superficial. In these cases, it is desirable to have a dressing which exhibits hemostatic properties. For example, the product Stasilon® is a novel hemostatic woven textile composed of allergen-free fibers of continuous filament fiberglass and bamboo yarn that has such an application. However, in addition to hemostatic properties, it would be desirable to have a dressing that also possesses enhanced wound healing properties.
Many individual cytokines and growth factors have been evaluated for their therapeutic utility in the treatment of many varied diseases, disorders and injuries. Unfortunately, the results have been only partially encouraging. For example, PDGF-BB has proven to be useful in the treatment of diabetic foot ulcers; GM-CSF is marketed in Europe for both venous ulcers and diabetic foot ulcers; and HGH (human growth hormone) is marketed in the US for pediatric burns. Failures include BDNF, CNTF and IGF-1 which have all been evaluated in clinical trials designed to test their efficacy in treating ALS, each with disappointing results; TGFβ2 was unsuccessful in a phase 2 study for venous ulcers; and IGF-1 and PDGF combination therapy was unsuccessful in diabetic foot ulcers.
While is not clear why so many of these individual cytokines and growth factors have failed in the clinic, one theory is that the proteins were being administered in doses that were not physiologic, i.e. very high doses compared to the physiologic levels normally found in vivo. Also, because of the complex interaction between cytokines and growth factors in a given physiological niche, the application of just one factor, especially one at abnormally high levels, cannot be expected to faithfully recreate the physiological niche and may, in fact, grossly disturb its delicate balance.